Noninvasive prediction of carotid artery atherosclerosis by multiple abdominal fat indices measured via ultrasonography

Purpose@#The purpose of this study was to evaluate the efficiency of multiple abdominal fat indices as measured via ultrasonography for predicting the presence and severity of carotid artery atherosclerosis and to compare the predictive capacity of ultrasonographic measurements to that of anthropometric measurements. @*Methods@#A total of 92 patients were included in this study. All participants underwent clinical and laboratory assessments, and anthropometric measurements were obtained. Ultrasound examinations were performed to measure the values of all abdominal fat indices and the intimamedia thickness, as well as to detect the presence of atherosclerotic plaques. Univariate and multivariate logistic regression analyses were performed. @*Results@#In the multivariate analysis, significant associations were detected between carotid artery atherosclerosis and posterior right perinephric fat thickness (PRPFT) (hazard ratio [HR], 15.23; P<0.001), preperitoneal fat thickness (PPFT) (HR, 4.31; P=0.003), visceral adipose tissue volume (VAT) (HR, 7.61; P<0.001), visceral fat thickness (VFT) (HR, 8.84; P<0.001), the ratio of VFT to subcutaneous fat thickness (VFT/SCFT) (HR, 9.39; P<0.001), and waist-to-height ratio (WHtR) (HR, 2.65; P=0.046). In the multivariate analysis, significant associations were also detected between carotid artery plaque and PRPFT (HR, 7.09; P<0.001), the abdominal wall fat index (AFI) (HR, 3.58; P=0.010), and VFT/SCFT (HR, 4.17; P=0.006). @*Conclusion@#Many abdominal fat indices as measured by ultrasound were found to be strong predictors of carotid artery atherosclerosis, including PRPFT, VFT/SCFT, VFT, VAT, PPFT, and WHtR. Moreover, PRPFT, VFT/SCFT, and AFI were identified as strong predictors of the presence of carotid artery plaque.

Prognostic values of intracranial pressure monitoring in severe closed head injury

The increased intra cranial pressure is the most significant factor determining morbidity and mortality in patients with severe closed head injury. The continuous monitoring of the ICP is very useful in assessing the ICP dynamics. The purpose of this study was to assess the effect of continuous ICP monitoring in determining the outcome of severe head injury. And how far ICP monitoring can limit the indiscriminate use of therapies to control ICP which themselves can he potentially harmful. Forty patients with severe head injury, with Glasgow Coma Scale [GCS] 8 or less, were involved in this study. On arrival to casualty unit, resuscitation started, general examination was done to assess cardiopulmonary system, and to detect any other associated injuries. All patients were intuhated, sedated, and ventelated. Intubation was facilitated with succinyl choline. Intracranial pressure [ICP] monitoring is done via ventricular catheter using hemodynamic monitor. Monitoring was continued for 48 hrs in controlled cases, and it was contintied when ICP was not controlled. Control of intracranial pressure was done by: I] -Brain dehydrating measures. II]-Dexamethason. III]-Cerebrospinal fluid drainage, and If ICP was still persistently elevated, trials were made to elevate mean arterial pressure [MAP] by using volume expansion and inotropics. These measures used to maintain cerebral perfusion pressure [CPP]. CT scan was done for all patients. Mean arterial pressure [MAP] and cerebral perfusion pressure [CPP] were measured and the injury admission time was recorded for all patients. The outcome was assessed according to Glasgow Outcome Scale. The outcome was divided into two groups: favorable outcome group and unfavorable outcome group. As regard to ICP, it's found that: 35% of cases had ICP<20 mm Hg. 64% of this group had favorable outcome while 36% had unfavorable outcome, Glasgow Coma Scale was >5 in 71% of cases and CT scan finding was normal and defuse lesion [N and D] in 64%. The intracranial pressure was >/= 20 mmHg in 65% of cases. 23% of this group had favorable outcome while 77% had unfavorable outcome GCS was > 5 in 38% of cases and CT scan findings were normal and defuse brain lesions [N and D] in 35% of cases. ICP was significantly higher in the unfavorable group [P<0.01] and injury admission time was significantly longer in the unfavorable group [<0.05], while the mean arterial pressure and cerebral perfusion pressure were significantly lower in the unfavorable group [P<0.05 and P<0.07 respectively]. Osmotherapy reduced the intracranial pressure 22.3 +/- 27%and the duration of reduction was 4.79 +/- 2.1 hours while the CSF drainage reduced the ICP 50.2 +/- 9.6% and the duration of reduction was 5.3 +/- 6.3 hours .The incidence of complication was slipped catheter in two cases. No cases of infection from the catheter were recorded. Mean duration of monitoring was 5 days [maximum 14 days]. The mortality rate was 35%[15 patients]. Intracranial pressure monitoring:[l] helps in early detection of intracranial pressure changes, [2] It can limit the indiscriminate use of therapies to control ICP which themselves can be potentially harmful[3] It can reduce ICP by CSF drainage directly and thus improve cerebral perfusion, [4] It helps in determining prognosis, and [5] It helps to improve the outcome. In prolonged monitoring [>4 days], daily bacteriological examination of CSF for early detection of contamination is recommended

Manegment of spontaneous intracerebellar haematomas

The term spontaneous intracerebellar hematomas means bleeding into cerebellar parenchyma without trauma. Cerebellar hemorrhage represents 10% of all spontaneous cerebral hemorrhage. Twenty patients with spontaneous intracerebellar hemorrhage were the material of this study to evaluate the outcome of both surgical and medical treatment modalities. Patient were divided into two groups according to the general condition of the patients and [the Hunt and Hess scale] and GCS for the level of consciousness, the first group contains five patients were treated conservatively, and the other fifteen patients were operated upon through a sub occipital craniectomy; and ventricular drainage. After resuscitation all cases were examined clinically after taking the history briefly, complete radiological investigations [CT brain scan MRI and MRA]. Evaluation of pathological causes, risk factors, clinical presentations, radiological findings, different management decisions and discussing factors affecting its outcome. Spontaneous intra cerebellar hemorrhage is a common neurosurgical emergency occurring with no much differences in both sexes; Uncontrolled systemic arterial hypertension, diabetes mellitus, and smoking were the commonest risk factors. Altered consciousnesses, acute sever headache, cerebellar manifestations, brainstem, manifestations, and hemiplegia was the commonest clinical findings. Intraventricular hemorrhage extension, hydrocephalic changes and obliteration of the quadrigeminal cistern were poor prognostic signs. The early the detection and management the best the outcome is. In case of large and rapid progressive increase in size of the IC hematoma needs rapid emergent surgical evacuation, and CSF drainage [in case of hydrocephalic changes]. should be on emergency bases too. The factors influencing the neurosurgical outcome in cases of spontaneous intra cerebellar hemorrhage are: The age of the patient and his general condition on admission.The early suspect and detection to save time avoiding deterioration of consciousness and neurological status. The state of consciousness at time of presentation and preoperatively that the patients with GCS 8 had a worse outcome. *The radiological findings the larger sized hematoma, the hydrocephalic changes. and obliteration of the quadrigeminal cistern the worse the prognosis, and are indicators for rapid surgical evacuating of the hematoma, and /or ventricular drainage. The more stable clinical course the best the results is. Rapid deterioration of the conscious level show bad diagnosis